Most claims for power wheelchairs don't meet Medicare criteria

An oversight report cites $112 million in improper payments. But a medical device association says the problem lies in documentation complexities.

By Chris Silva — Posted Jan. 21, 2010

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An oversight report by the Dept. of Health and Human Services Office of Inspector General, released in December 2009, concludes that the federal government and Medicare beneficiaries are footing the bill for millions of dollars in improper payments made to suppliers of power wheelchairs.

The OIG selected a random sample of 375 claims for both standard and complex rehabilitation power wheelchairs supplied in the first half of 2007. Three out of five claims for the equipment did not meet Medicare documentation requirements, resulting in $112 million in improper Medicare payments. Beneficiaries were responsible for paying $22 million of this amount, according to the report.

Standard power wheelchairs accounted for nearly three-quarters of Medicare's power wheelchair claims in the first half of 2007. To receive a complex rehabilitation wheelchair, a beneficiary's limitation must be deemed to result from a neurological condition, muscle disease or skeletal deformity. These chairs accounted for less than 7% of power wheelchair expenditures in the first half of 2007, but they had a higher documentation error rate, at 93%, than standard power wheelchair claims, at 58%.

In addition, two out of five power wheelchair claims had multiple errors, and suppliers submitted incomplete documentation nearly three times as often as they failed to submit required documents, OIG said.

The American Assn. for Homecare, which represents firms providing durable medical equipment, prosthetics, orthotics and supplies, said the report confirms that documentation requirements are too confusing and onerous to follow.

"The OIG report actually confirms what wheelchair providers and physicians have said for the past three years -- the Medicare documentation requirements for power wheelchairs are inconsistent, far too complex, and must be improved so both physicians and wheelchair providers can serve patients and successfully meet Medicare regulations," said Tyler J. Wilson, the association's president.

OIG recommended that the Centers for Medicare & Medicaid Services conduct additional reviews of claims, recover overpayments from suppliers that do not meet documentation requirements, and increase documentation education for suppliers and physicians.

CMS responded that it has multiple efforts under way to improve compliance, OIG said.

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